Can you fly safely?

By Sean J. Ennevor, MD

Guest Contributor

Travel of any sort can be a stressful experience for all, but there are special considerations for airline travel. Even prior to flying, one may have long distances to walk, baggage to carry, and encounter high levels of stress during air travel. While in flight, barometric pressure, noise, oxygen levels, or even the spaces where one sits all differ from what most people are familiar with.

The cramped aircraft cabin spaces make it difficult to move about freely. This immobility is known to increase the risk for medical conditions such as deep vein thrombosis or pulmonary embolus. Both of these life-threatening conditions are more likely as one’s blood thickness (viscosity) goes up but your entire blood volume goes down, thus making clotting more likely.

Aircraft have less humidity, lower ambient pressure, and lower temperatures within the cabin than other environments. Compared to sea level, there is lower barometric air pressure, lower humidity, and lower oxygen content.

The pressure within the aircraft cabin is equivalent to being at 5,000 to 8,000 feet of altitude. At that altitude there is less available oxygen in the air for one to consume. Although airflow exchange within the cabin is reported to be three times the rate seen to control hospital room infections, cold flu and other viruses still likely remain on airplane surfaces.

None of the above are ideal for patients with certain medical conditions, and some of these conditions are disproportionately seen in people of color. They include heart disease, lung disease, diabetes, and blood vessel disease. All listed conditions may be worsened by air travel due to the changes in the environment listed above.

Conditions such as hypertension, angina or diabetes can be challenging to manage as traveling across time zones will impact medication timing or availability.

Time zone changes as one flies may cause “jet lag,” which presents as fatigue, difficulty sleeping, and sometimes confusion.

All symptoms are similar to what is possible during poor blood sugar control, stroke, or blood pressure changes from baseline.

Conditions such as hypertension, angina or diabetes can be challenging to manage as traveling across time zones will impact medication timing or availability.

Additional conditions of note include any recent post-surgical patient; they have increased needs as a lower blood count, or anemia, sometimes due to a procedure’s blood loss, increases oxygen needs even more.

Gastrointestinal issues are common during flight as trapped gasses expand in one’s gut as altitude increases. A recent abdominal surgery or colonoscopy both have the potential for gas to remain within enclosed body spaces immediately after the procedure. Flying soon after such procedures could cause gas expansion in one’s gastrointestinal tract. The recent procedures and lack of access to one’s regular diet may lead to extreme distress from gas pains.

Dehydration is also a common condition when flying due the lower cabin pressures and dry air, as the higher one goes the drier it gets. Blood pressure may also be elevated or decreased during air travel due to lower cabin pressures and the overall stressors of travel.

The consumption of caffeine and alcohol will cause additional drying of airways, skin or eyes. Drying of mucosal surfaces is irritating and will exacerbate coughs, cause severe cracks in skin, or even create issues with one’s contact lenses if worn.

In general, an individual with any unstable medical condition should get clearance from their physician prior to flying. Anyone with poor blood pressure control, asthma, emphysema, recent stroke, or recent surgical procedure (including ear or neurosurgical procedures) should make their provider aware that they are traveling.

Special consideration should be taken with air travel during pregnancy, as the physiologic changes of pregnancy may increase the risk of DVT, cause premature delivery or placental issues. Abdominal trauma from the “lap belt” during turbulence could also be detrimental during flight.

Psychiatric conditions can also be worsened by airline travel due to the added stressors, some psychiatric medi- cations that affect digestion, and anxiety triggers due to enclosed space with crowding. themselves result in an arrest or citation.

What can one do?

1) Talk to your provider if you are uncertain of the impact of air travel with your current conditions.

2) If on medications, have a plan to be consistent as to when to take them (carry medications on board).

3) Wash hands often and keep hands from your face.

4) Move frequently during air travel, which may help with GI issues and blood circulation.

5) Consider lower body compression garments to help with preventing clots.

6) Plan out diabetic management needs, particularly if crossing time zones.

7) Plan to arrive early and focus on relaxation techniques to lower stressors as you are able.

8) Stay hydrated with water while traveling and consider skipping alcohol and large amounts of caffeine.

Statistically, flying is a very safe and efficient way to travel if able, but with these considerations the experience can be made even safer and more comfortable.

Sean J. Ennevor, M.D. graduated with a B.A.S. in biology and economics from Stanford University, and as a Dean’s Scholar from UCLA School of Medicine where he received his MD. He completed his medical residency and fellowship in anesthesiology at Yale University, where he was chief resident and on staff. He practiced medicine in the Twin Cities for over 14 years, and presently serves as an advisor and investor for medical technology companies throughout the country.

Continued from page 1 agreement. It is only the court that can and will end this agreement after the City reaches full, effective and sustained compliance with the terms of this agreement,” said Human Rights Commissioner Rebecca Lucero.

The agreement, which differs from a consent decree, includes developing a training curriculum for officers who want to be field trainers within 30 days. “The field training officer position was a part-time role that relied on volunteers and self-selection. And that led to inconsistent training,” said Minneapolis City Council Vice President Linea Palmisano.

It will also require the department to develop clear policies and procedures to make discretionary choices and searches. Officers and the public will have 45 days to comment on those policies and Minneapolis police officers will have to engage the community in multiple languages and at places and times convenient for both parties. The only exception is if the Peace Officers Standards and Training (POST) board requires that changes be made. The Minneapolis Police Department will evaluate the policies annually. The agreement also bans pretextual stops, as well as discrimination based on race, gender or other protected classes. Officers will be required to tell individuals they stop why they are being stopped, and provide their business card upon request, or if a stop does not

They will also need to activate their body camera, document why the stop happened, and provide the case number to the person they stopped upon request. The agreement does not ban stops where there is reasonable suspicion of criminal activity. The MPD will also be required to develop training on how officers should take a trauma-informed approach to interacting with minors within six months. Minneapolis police officers will also have to offer access to mental and behavioral health and substance abuse services.

The agreement will also require the City to create a panel composed solely of the police chief, command staff, and police officers responsible for making policy changes within six months of when the agreement goes into effect, to review use of force, stops, searches and arrests to determine if it influences a policy change. The agreement goes into effect once the court approves it. It will also limit use of force to what is reasonable, necessary and proportional based on what the officers are facing, and require them to use de-escalation tactics. They will also be required to produce a report on use of force and promptly obtain medical treatment for those injured. They will not be able to direct paramedics to sedate those under their care with any medication, including ketamine, if they suspect the person being arrested is experiencing excited delirium.

The agreement also stipulates that officers cannot use chemical agents or crowdcontrol weapons to influence and apprenticeship training programs to make sure this happens,” said Biden. or disperse a crowd unless approved by the MPD chief, or unless officers and other people are facing imminent threat. In such cases, chemical agents and crowd-control weapons can only be used on the person initiating the threat.

• Bans excited delirium training

• Officers can no longer be coached or verbally notified, without documentation of their misconduct being included in their record takes effect.

At a press conference hosted by the City on Friday morning, MPD Chief Brian O’Hara welcomed the agreement.

“This agreement will ensure that Minneapolis police will have the policies, training, support and resources that they need to deliver the highest quality of policing services that our residents deserve,” said O’Hara.

In response to a question that existing policy requires what the court-enforceable agreement asks for, O’Hara said, “You have a mandate to make certain investments that cities just do not make, because this is a very expensive process. It’s very manpower intensive. And ultimately, you have to prove to near perfection to an independent evaluator and independent monitor that your cops are actually carrying this out,” says O’Hara.

For chemical agents, officers must provide ample warning to individuals before dispersing the agent. Even then, they can only use enough of the chemical agent to make contact with individuals and evaluate if they need to disperse more. Officers will not be able to use chemical agents on anyone who is handcuffed or restrained.

The MPD will also be required to create a searchable database of disciplinary action for all officers rendered on and after June 8, 2020, within 90 days. They will also be required to create a website where people can report officer misconduct.

Additional requirements include:

• Requires off-duty officers to abide by on-duty guidelines while picking up side work

• Requires officers to identify

• Prohibits retaliation

• Implements early intervention system

It will also require the City to hire an independent evaluation firm that will ensure Minneapolis complies with the consent decree within 120 days of the effective date of the agreement. The evaluator will provide progress reports twice a year, allow the public to provide feedback on it, and survey the public annually on how satisfied they are with the policy changes. They will also maintain a website that has their budget, evaluation plan, court filings by the City and DHR, and schedules of upcoming meetings. The City will also create a unit to liaise between the mayor and the independent evaluator, to implement the agreement within 60 days of when it

Even with the changes outlined in the agreement, the city says they have already implemented what has been stipulated. O’Hara says it’s promising, even though they remain over 150 officers short, they have seen an increase in applications to the agency and are speaking with some officers who want to return. The chief also says the city is safer than it was a year ago.

The agreement does not address DHR findings that Minneapolis police officers targeted activists of color without a public safety objective, which the City disagreed with. Instead, the City continues to require police officers to justify the reasons for their actions. These accounts will be subject to examination by a review panel.

The agreement also allows the City to avoid admitting any wrongdoing. “We don’t have to admit to all findings … because we want to resolve legal claims,” said City Attorney Kristyn Anderson.

The Department of Human Rights filed another lawsuit in Hennepin County District Court with the updated agreement to get court approval. The court will then decide how to move forward.

The city is not sure how much it will cost to implement the agreement. However, they anticipate having to invest heavily in information technology and early intervention systems. Mayor Frey’s budget has set-aside $2 million for investments this year and proposes $3 million for next year. “I am not confident that will be enough,” said Frey.

Meanwhile, the DHR will implement the courtenforceable agreement using resources they get from their annual request to the governor and lieutenant governor. This year, they are requesting $1.7 million over the next two years, which would allow them to hire two more full-time equivalent staff.

The agreement will be implemented in the MPD by first training police captains, who will then train the rank-and-file officers. O’Hara cautions that change won’t happen overnight. “Next week does not look much different than today,” said O’Hara. “This is not something that the city has gotten into overnight, and we’re not going to get out of this completely overnight.”

H. Jiahong Pan welcomes reader responses to hpan@spokesmanrecorder.com.

Continued from page 1 the next seven years.

The bill also calls for investment in technical trades programs to train people to work at these jobs. “We’re working with companies, community colleges, technical schools, union members,

Blue line

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Cummins currently employs about 2,000 people across its three Minnesota facilities—its two other facilities in Shoreview and White Bear Lake—1,000 at the Fridley plant, 600 of whom currently work on generators that will be retrained to produce electrolyzers. They will also hire an additional 100 people to support its production.

“That [planning] allows for interaction of customers and pedestrians and community members to engage in commerce in a comfortable way that is accessible to bikes, pedestrians, autos and buses,” he adds. “When you make this shift to putting light rail down West Broadway,” he continues, “it flies in the face of all the development principles that we’ve been investing in for decades.”

It also makes it hard for Teto Wilson, who owns the building that houses his business—Wilson’s Image Barbers and Stylists, across the street from Broadway Liquor Outlet—to decide whether or not to buy other buildings along the corridor to rebuild.

“You’re literally taking a building I would have purchased at full price and you’re making it much smaller,” said Wilson, referring to a building he is interested in that the Met Council wants to remove five feet of to allow the light rail to pass through. “[It’s] putting a lot of people that have projects either in the works or in their minds in a holding pattern.”

Parking is also another issue for business owners such as Tara Watson, who owns a chiropractic prac-

Although hydrogen is the most abundant element in the atmosphere, it is also hard to isolate by itself. It can be obtained by shocking water into hydrogen and oxygen in an electrolyzer, but most of the hydrogen produced today involves blowing hot steam on methane gas. Aside from Cummins’ efforts in Fridley, St. Cloud received $1.09 million from the state to install an electrolyzer at their wastewater treatment plant. Despite the investment, tice and franchises an Anytime Fitness on West Broadway. “We already struggle with parking on the avenue [at] certain times of the day because of the on-street parking regulations,” says Watson. “It just makes it really, really difficult now for you to reduce it down to one lane on each side with something going through the middle, congesting the area more [and] taking away people’s businesses.”

Business owners like Wilson are also worried that removing parking will make it harder for those with mobility access needs to visit their businesses by Metro Mobility or taxi.

“If I have a customer that’s in one of those Metro Mobility vans and they pull up in front of my business, they’re not going to be able to stop, get out, use the ramp, let the customer out, and bring them into the shop,” worries Wilson. “Because you’re gonna create a traffic bottleneck.”

People may have a harder time getting to West Broadway businesses by light rail because the Met Council is proposing up to three stops on West

Broadway, which is less than the nine and a half bus stops that exist today. Depending on the alternative, trains may either stop at Illion/James and Aldrich/Bryant or just at Emerson. Both alternatives call for the light rail to also stop at Penn.

“The train is gonna go right past all these other businesses,” said Wilson. “I just don’t see how it’s going to truly benefit the people here. What about us that have businesses here? It’s gonna be more of a negative impact for us versus having people to … not have to drive any longer.”

Some West Broadway business owners believe the Met most hydrogen fuel cell vehicles mostly exist in California, with some examples being used in public transit facilities in Illinois and Ohio. And although no Minnesota agency has immediate plans to use vehicles powered by hydrogen, New Flyer in St. Cloud is one of two bus manufacturers in the U.S. who produces hydrogen-fueled buses.

H. Jiahong Pan welcomes reader responses to hpan@ spokesman-recorder.com.

Council would be better off running a shuttle with San Francisco-like cable cars or building a rapid transit bus route, similar to the C and D lines. “I don’t think you’re going to have anyone complaining about a [line similar to the] C Line compared to a rail line,” said Wilson. Metro Transit does indeed plan to build such a route on West Broadway after 2030, that runs to Robbinsdale Transit Center and 38th Street Station via Washington and Cedar Avenues, replacing Routes 14 and 22.

It’s possible that some of the concerns businesses have may be addressed later this year when the Met Council releases its report required by the federal government on how the project will affect the surrounding neighborhood, and what they plan to do to mitigate those concerns.

Although Metro Transit staff did not respond to repeated email requests to comment on West Broadway corridor businesses’ concerns, they plan to host community meetings to get more feedback this coming month. Their next meeting will be on Monday, April 17, from 5 – 7 p.m., at Sanctuary Covenant Church, 710 W Broadway Ave. They also have a virtual meeting scheduled for Wednesday, May 17, from 5 – 6 p.m.

H. Jiahong Pan welcomes reader responses to hpan@spokesmanrecorder.com.